Letter from a Medical Student: OB/GYN Edition

Sean did his Ob/gyn rotation in September and October and finally had a chance to record his experience over our winter break. Enjoy=)

Letter from a Medical Student: Ob/Gyn Edition

Following a much-needed but all-too-short two week break, I started

the fall rotations with Obstetrics and Gynecology, a rotation I was

not necessarily looking forward to very much. This was for two primary

reasons: this would be a rotation all about women's health (women: can

you imagine having to spend a month about nothing besides men's

health?), and it is also a surgical specialty, which means time in the

Operating Room. I had a feeling I would not like the OR.

I dove head first into the Urogynecology clerkship, and learned for

the first two weeks to talk all about prolapse and incontinence. Joy!

To top it off, my first day was in the operating room with three

back-to-back hysterectomies.

As you probably know from Hollywood films, surgeons (and gynecologists

in the OR) have to scrub in to do a surgery. This means a meticulous

2-4 minutes of scrubbing with intense soap to your elbows, then

walking backwards into the OR and donning a sterile gown and two sets

of gloves. Once sterile, your arms need to stay between your belly

button and your shoulders - stray from this area, touch anything you

shouldn't, tear anything, and you have to start all over. Once

scrubbed, the third year medical student typically finds him/herself

as somewhat of an audience to the real action going on in the surgery.

We have zero training about the surgery itself, so our role is

confined to cutting sutures after they've been tied, holding

retractors (sometimes for hours) so the surgeons can work without a

uterus or a liver getting in their field of view. If you're lucky,

when the main surgery is ended (and the attending physician has

usually already left the room) the resident may let you help close the

patient. This means either stapling - which is my favorite for its

ease of use - or suturing closed the incisions made for the surgery.

Take too long, place a suture incorrectly, or get on the bad side of

the resident, and you won't be doing that either.

During these first three surgeries, I didn't get the luxury of any of

those chores. Instead I got to watch the backs of the attending and

two residents as they performed the surgery - sometimes there just

isn't room for the medical student, and the residents' education takes

precedence over ours. As I learned later, there really isn't much to

see anyway. Even so, it gets a bit boring standing for hours with your

arms together at your belly button, trying not to sweat to death with

your mask and eye shield and gown locking in all the heat.

After two weeks of clinic asking women about if they urinate every

time they sneeze or cough, I was somewhat relieved to move on to

Benign Gynecology. This is a world of bleeding and cysts, all of the

problems with the reproductive organs that doesn't involve cancer.

Here I met one of the most fantastic residents I have encountered in

medical school.

Have I mentioned how critical the residents are to any clerkship? No

matter the topic of the rotation, if you have a good team of residents

who welcome the medical students, appreciate their presence, and take

the time to teach them and encourage them to improve in a positive

way, the rotation will be fun and productive. Likewise, the most

interesting and engaging specialty can be crushed under the weight of

a resident who ignores your existence or who is belittling.

However, I learned a sobering truth during Benign Gynecology: surgery

is never a trivial undertaking. One fateful morning, we began another

case of performing a hysterectomy on a lady who simply wanted her

fibroids (lumps of harmless but sometimes annoying tissue in the

uterus) removed permanently. Her elective surgery appeared to go

without event, and I actually got to help out a little bit with that

surgery. One of the residents showed me one of the uterine arteries

that was bleeding profusely before they sutured it closed, and I was

surprised to see that amount of blood flow for such a little organ.

We finished the surgery, and although she took a little longer to wake

from the anesthesia than normal, we didn't think much of it as she got

sent to the post-operative recovery area. Only after a half hour or so

did the problem become apparent. Her belly had become distended, her

blood pressure starting dropping and her heart began racing; alarms

began going off on her vital sign monitor. We rushed her back to the

OR, and I have never seen such a flurry of activity as a dozen people

sprang into action to get everything necessary to re-open her and

begin a massive blood transfusion. We medical students were (with good

reason) shunted aside and eventually asked to leave the room, but not

before the anesthesiologist looked over the drape straight in the eyes

of our resident and said, "She's coding. Begin chest compressions."

We say a patient has "coded" when they are dying - their breathing has

stopped, their heart has stopped, when they have only seconds or

minutes to live without CPR and emergency resuscitation before they

die. I was horrified: a perfectly healthy patient who simply wanted

something annoying removed now had a heart that was no longer beating.

All because of that little artery that I had seen bleed, which had

burst the sutures placed to quell its flow, and had bled out enough to

kill her had the team not intervened and saved her life.

With that harrowing scene fresh in my mind, I stepped into the Labor

and Delivery ward for two weeks, to help patients deliver their

babies. I enjoyed L&D much more than I expected; for all of the

waiting and drowsiness during the 12 hour night shifts, it is really

miraculous and spiritually uplifting to see a patient work so hard and

bring a new life into the world. My role involved lots of cheering

them on, "Keep it up! Push just like that! Okay, now take deep

breaths..." and lots of delivering placentas (gross, but very

important).

As intense as the weeks may sound, I ended up enjoying Ob/gyn much

more than I anticipated. Not nearly enough to change my mind about

going into Family Medicine; rather, just enough to make me appreciate

the Ob/gyn patients that I'm sure to see in my clinic someday, and

look forward to the times that I'll have to come in to the hospital to

deliver one of my patient's children. As worn out as I was of the

operating room, though, it was nothing compared to the days and days

of OR that awaited me in Surgery...